The magic words for insurance (for me, at least)

[Guest guest]

Hi ,

For me, it took years to finally figure out the " magic words " to get insurance

to cover my

condition: " skeletal deformity " . Mind you, I don't look deformed, but both of

my jaw

bones are too short to maintain a healthy jaw relationship and a healthy bite,

so I need to

have mine surgically extended to fix it. It's been a battle, but with enough

documentation,

letters from doctors, xrays and digital pictures (and those magic words), I've

finally been

approved. My surgery alone will be $41K, not to mention the $7K I've paid out of

pocket

for the braces, and approximately $1500 per year for a new splint and the splint

adjustment visits, for the last 6 years (also out of pocket). And even though

insurance

doesn't pay all of the surgery, they'll pay a good chunk of it, and every little

bit counts!

Good luck,

Jen

(surgery date: November 10th, 2005)

> emailmaryw <emailmaryw@y...> wrote:

>

> Hello! I'm new here and just wanted to say what a huge help this

> site has been so far. I'm 29 years old and am getting ready to have

> jaw surgery for the 2nd time. I had a fairly severe underbite and crossbite

as a child

> and had surgery for it when I was 14 years old. It was a pretty rough

experience but I'm

> glad I did it. The orthodontist that I've been seeing was schocked that I had

the

> surgery so young. My surgeon thought that I had quit growing but - surprise!

- I didn't

> and my bite has relapsed over the years. I have my first surgery consultation

this

> Wednesday with a Dr.Roser at the Emory Orthognathics Dept in Atlanta. I'm

nervous but

> also a little be excited....I've known for a long time that I needed to have

surgery

> again and finally feel ready to go through the process all over again.

>

> My biggest concern right now is with insurance coverage. My first surgery was

not

> covered (even after many appeals) and it cost over $50K! (I almost died when

my

mother

> told me how much it had all cost) From what I've been reading it seems like

the prices

> have come down but I'm still terrified at the idea of paying for this out of

pocket. I have

> United Healthcare and have been looking through my booklet on their exclusions

and

> included services - in one section it says any orthgnathics procedure is not

covered but

> then somewhere else it says that treatment for TMJ would be covered. I don't

really have

a

> lot of jaw pain (TMJ) but I wondered - how willing are surgeons to help you

out with

> submitting something under a certain code, even if that code does not

necessarily best

fit

> your problem? I'm just wondering if there is a way to approach this with the

insurance

> company that would make it more likely to be accepted?

>

> If anyone has any advice on insurance codes or working with United Healthcare

I would

> greatly appreciate it!

>

> Thanks!

> W.

>

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